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How can medical treatments such as dialysis —a potential lifeline for people with Chronic Kidney Disease (CKD) — be done more sustainably? While dialysis is essential for CKD patients, it is resource-intensive, for example, in the United Kingdom alone, hemodialysis for each patient is responsible for 3.8 tons of CO2-equivalent emissions annually, seven times more than the average carbon footprint per patient*. Until now, its environmental impact has often been an afterthought in healthcare decisions. Two teams from the University of Twente and the Radboudumc will collaborate using a grant from the TURBO program to find out what the medical benefits and ecological costs are of two types of dialysis.
Dr. Shiva Faeghinezhad, who specialises in engineering and computer simulation at the University of Twente, and Dr. Hugo Touw, a medical specialist at Radboud university medical center (Radboudumc), are assessing – as a case study - the environmental impact of two types of dialysis: hemodialysis (HD) performed in a hospital and peritoneal dialysis (PD), which patients can do at home. They aim to build a framework that helps hospitals and clinics prioritize medical treatments balancing clinical outcomes with environmental responsibility.
Approach
To create this framework, they combine Life Cycle Assessment (LCA) with Health Technology Assessment (HTA) in a novel way. This approach gives them a complete view of the medical benefits and ecological costs. LCA traces every step in the lifecycle of dialysis treatment — the materials used to build dialysis machines and equipment, water and energy consumption, waste, and even transport of materials and healthcare staff. It quantifies the ecological footprint of the two types of dialysis.
HTA is a standard method in healthcare, helping answer questions like: Which dialysis method works best for what type of patients? And which gives the most value for the costs spent? Faeghinezhad and Touw will review existing studies and economic analyses to understand the costs and benefits of these treatments. They will also run computer simulations to predict outcomes for different types of patients, such as someone with other health conditions, and test the reliability of their results by tweaking certain assumptions.
“This project is a critical step toward a more sustainable healthcare system. we integrate environmental considerations into how treatments are evaluated. The goal is to create a healthcare sector that heals people and protects our plane", say the researchers.
Data is key, but so is human judgement. Faeghinezhad and Touw and their teams will interview a broad spectrum of people—HTA experts, environmental specialists, nephrologists, patients, hospital staff, medical product manufacturers, and insurers. These conversations will help them fill in the gaps, ensuring the framework reflects the complexities of real-world healthcare.
As promising as this approach is, it is not without its challenges. One of the biggest difficulties is gathering comprehensive, accurate data. LCA and HTA require detailed information, such as how dialysis machines and equipment are made and transported or how different treatments impact individual patients over time. To address this, the team will review existing studies and work closely with stakeholders.
They foresee keeping everyone involved as another challenge. Doctors, hospital administrators, and policymakers all play a role in making healthcare more sustainable, but ensuring their consistent involvement can be tricky. The team will hold regular meetings and conduct interviews to keep communication open and consistent.
Goal of Framework
Faeghinezhad and Touw's short-term goal is to test the framework in real-world settings and refine it. In close collaboration with colleagues that are working on the same kind of challenges. They believe the framework could be applied to a range of treatments in the long term, helping hospitals prioritise options that are effective, affordable, and environmentally responsible. It could also encourage policymakers to factor sustainability into healthcare funding and planning.
This framework could help reduce the environmental impact of healthcare, aligning with global initiatives like the Green Deal on Sustainable Healthcare. For patients, this means better access to treatments that improve their health without harming the planet. For healthcare providers, it is a way to balance their dual responsibilities to people and the environment.
HealthTech Nexus and the TURBO program
HealthTech Nexus is the strategic collaboration between Radboudumc and the University of Twente at the intersection of healthcare and medical technology. Together they focus on the 'unmet need' of healthcare: urgent needs for which no good solutions yet exist.
This strategic platform brings together knowledge and expertise within a broad network of stakeholders inside and outside the healthcare sector. To keep tomorrow's care patient-oriented, sustainable, affordable and accessible, collaboration is crucial. Other parties are explicitly invited to join.
Faeghinezhad and Touw's project is one of four projects honored by the TURBO program (Twente University RadBoudumc Opportunities).
For more information about HealthTech Nexus and the TURBO program visit University of Twente (TechMed Centre) or Radboudumc.
References
* https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-022-00867-9
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